Opie J C, Izdebski T, Payne D N, Opie S R
Scottsdale Healthcare, AZ, USA.
Phlebology. 2008;23(4):158-71. doi: 10.1258/phleb.2007.007075.
Previous reparative valvular surgical options directed at reconstructing damaged common femoral vein (CFV) valves associated with pathological chronic venous insufficiency (CVI) have not succeeded in reliably managing CVI. In consequence, venous valvuloplasty is rare and most patients are managed conservatively. As a result, monocusp surgery was identified as an optional surgical solution for this large underserved patient group.
Ulcer patients appear at wound clinics and often experience disappointing results. Monocusp valves were constructed utilizing viable vein wall in 14 operations on 11 patients. These patients were observed for four years to see if such an autogenous vein wall valve might control aggressive symptomatic CVI when faced with unusable valves.
Long-term follow-up showed that the monocusp valves remained competent at four years. Symptomatic failures have not appeared at this time. Pain, swelling, ulcers and leg congestion were reliably reversed. VEnous INsufficiency Epidemiologic and Economic Study (VEINES) classification (see Abenhaim L, Krux X, VIENES Study collaborators. Angiology 1997;48:59 and Kurz X, Kahn SR, Abenhaim L, et al. Int Angiol 1999;18:83-102) improved over four years from 2.7 +/- 0.9 to 0 (P < 0.001); CEAP classifications (see Kistner RL, Eklof B, Masuda EM. Mayo Clin Proc 1996;71:338-45) improved from grade 4-6 to 0-1 (CEAP is not generally a postoperative grading system, but it can be used to develop some form of qualitative analyses as to intervention effectiveness, i.e. what existed preoperatively no longer exists postoperatively. Its postsurgery use is limited by (C5) classification - history of ulcer, which by definition cannot go below that with a history of ulcer even if the ulcer has been cured). Mean venous reflux scores decreased from 3.8 +/- 0.4 to 0.3 +/- 0.5 (P < 0.001).
Monocusp implantation reliably resolved patient symptoms when unusable CFV valves were encountered. Postoperative CFV reflux is usually undetectable. The monocusp valve exhibits minimal thrombogenicity related to its viability with attendant antithrombotic hormone production capacity and has markedly improved the patient's quality of life. Full thickness monocusp surgery could become widespread with the difficult dysplastic/aplastic CVI patient subset because of its simplicity, repeatability, durability, low complication rate, effectiveness, persistent availability and viability providing nitric oxide synthase and thymomodulin hormone production capacity. The full thickness of vein wall has distinct advantages over other partial thickness valve creation methods because of its long-term vitality. Postoperative coumadin is recommended for six months to minimize risks of deep vein thrombosis and/or pulmonary embolism.
以往针对与病理性慢性静脉功能不全（CVI）相关的受损股总静脉（CFV）瓣膜进行修复的瓣膜手术方法，未能成功可靠地治疗CVI。因此，静脉瓣膜成形术很少见，大多数患者采用保守治疗。结果，单尖瓣手术被确定为这一大量未得到充分治疗的患者群体的一种可选手术解决方案。
溃疡患者出现在伤口诊所，且常常经历令人失望的结果。在11例患者的14次手术中，利用有活力的静脉壁构建了单尖瓣。对这些患者进行了四年的观察，以了解这种自体静脉壁瓣膜在面对无法使用的瓣膜时，是否能够控制侵袭性症状性CVI。
长期随访显示，单尖瓣在四年时仍保持功能正常。此时尚未出现症状性失败情况。疼痛、肿胀、溃疡和腿部充血均得到可靠缓解。静脉功能不全流行病学和经济学研究（VEINES）分类（见阿贝海姆L、克鲁克斯X、VEINES研究协作组。《血管学》1997年；48:59以及库尔兹X、卡恩SR、阿贝海姆L等。《国际血管学》1999年；18:83 - 102）在四年间从2.7±0.9改善至0（P < 0.001）；CEAP分类（见基斯特纳RL、埃克洛弗B、增田EM。《梅奥诊所学报》1996年；71:338 - 45）从4 - 6级改善至0 - 1级（CEAP一般不是术后分级系统，但可用于对干预效果进行某种形式的定性分析，即术前存在的情况术后不再存在。其术后使用受到（C5）分类——溃疡病史的限制，根据定义，即使溃疡已治愈，也不能低于有溃疡病史的级别）。平均静脉反流评分从3.8±0.4降至0.3±0.5（P < 0.001）。
当遇到无法使用的CFV瓣膜时，单尖瓣植入可靠地缓解了患者症状。术后CFV反流通常无法检测到。单尖瓣因其具有活力并伴有抗血栓激素产生能力，表现出最小的血栓形成性，且显著改善了患者的生活质量。全层单尖瓣手术可能会在难以治疗的发育异常/发育不全的CVI患者亚组中广泛应用，因为其操作简单、可重复性强、耐用、并发症发生率低、有效、持续可用且具有活力，可产生一氧化氮合酶和胸腺调节素激素。与其他部分厚度瓣膜制作方法相比，静脉壁的全层具有明显优势，因为其具有长期活力。建议术后使用华法林六个月，以将深静脉血栓形成和/或肺栓塞的风险降至最低。
